Sage + Ethinyl Estradiol, Norethindrone, Ferrous Fumarate
Ethinyl Estradiol, Norethindrone, Ferrous Fumarate brand names: Estrostep Fe, Loestrin Fe, Microgestin FE, Junel Fe 1.5/30, Loestrin Fe 1.5/30, and others.
Ethinyl Estradiol, Norethindrone, Ferrous Fumarate falls into 3 drug categories that Sage can interact with; the most serious is rated moderate. Theoretically, sage might increase levels of drugs transported by P-glycoprotein.
Read the full interaction reportSage and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Sage interacts with whole categories of medication. Ethinyl Estradiol, Norethindrone, Ferrous Fumarate falls into 3 of those categories, so it can interact with Sage in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
P-GLYCOPROTEIN SUBSTRATES
1 of 3Why this applies to Ethinyl Estradiol, Norethindrone, Ferrous Fumarate
Ethinyl Estradiol, Norethindrone, Ferrous Fumarate falls under P-GLYCOPROTEIN SUBSTRATES — the group Sage interacts with.
In vitro research suggests that common sage (Salvia officinalis) can inhibit the multi-drug transporter protein, P-glycoprotein. This effect has not been reported in humans.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the honest version for your birth control pill (the combo of ethinyl estradiol, norethindrone, and iron). In lab dishes, sage seems to block a cellular pump called P-glycoprotein that helps move certain medicines around your body. In theory, slowing that pump could let a bit more of the hormone hang around, which might mean more of the usual estrogen-type side effects like nausea, breast tenderness, bloating, or spotting.
But I want to keep this in perspective. This is only seen in test-tube studies, not in real people, and it has never actually been reported as a problem. Normal cooking amounts of sage are very unlikely to matter. If you take strong sage extracts or essential oil regularly, just mention it to your pharmacist or doctor so they can keep an eye on things.
- Hellum, B. H. and Nilsen, O. G. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol. 2008;102(5):466-475.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 3Ethinyl Estradiol, Norethindrone, Ferrous Fumarate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP3A4. So far, this interaction has not been reported in humans.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Your birth control pill (the ethinyl estradiol and norethindrone part) is processed by a liver enzyme called CYP3A4. In test-tube studies, water-based sage extracts seemed to slow that enzyme down a bit. If that happened in the body, the estrogen in your pill could build up slightly, which in theory might mean more of the usual estrogen-type side effects like nausea, breast tenderness, bloating, headaches, or spotting.
Here is the reassuring part: this is only lab data, and it has never actually been reported in real people. The pinch of sage you cook with is very unlikely to do anything. Concentrated sage extracts or capsules are the bigger question mark. If you plan to use sage supplements regularly, just run it by your pharmacist or doctor first.
- Foster BC, Vandenhoek S, Hana J, et al. In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 2003;10:334-42.. PubMed
- Hellum, B. H. and Nilsen, O. G. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol. 2008;102(5):466-475.
ESTROGENS
3 of 3Ethinyl Estradiol, Norethindrone, Ferrous Fumarate also falls under ESTROGENS.
In vitro evidence suggests that geraniol, a constituent of Spanish sage (Salvia lavandulaefolia), exerts estrogenic activity. The clinical significance of this effect is unclear.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the honest version of this one: your birth control pill (Loestrin Fe, Microgestin Fe, and similar brands) contains estrogen and a progestin to prevent pregnancy. The concern with sage is purely theoretical. In lab dishes, a compound found in Spanish sage showed mild estrogen-like activity. Nobody has shown this actually changes how your pill works in real people.
So in practice, sprinkling sage on your dinner is not something I'd worry about. There's no good evidence it weakens your pill or causes spotting, mood changes, or breakthrough bleeding. If you're thinking about concentrated sage extracts or sage essential oil regularly, that's worth a quick chat with your pharmacist or doctor, mostly to be cautious. Don't stop your pill over this.
- Perry, N. S., Houghton, P. J., Sampson, J., Theobald, A. E., Hart, S., Lis-Balchin, M., Hoult, J. R., Evans, P., Jenner, P., Milligan, S., and Perry, E. K. In-vitro activity of S. lavandulaefolia (Spanish sage) relevant to treatment of Alzheimer's diseas
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
- ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
- UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
- AHigh-quality meta-analysis (quantitative systematic review).
- BCase-control study.
- CConsensus.
- DAnecdotal evidence.
These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.
Sage Also Interacts With Other Medications
Sage has 1,296 moderate known drug interactions in our database — the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Sage
We haven’t checked that one against Sage yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Sage. Pick one to open its full report.
See Every Supplement That Interacts With Ethinyl Estradiol, Norethindrone, Ferrous Fumarate
This page covers Sage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate page lists 240 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).
By severity: 6 major · 196 moderate · 38 minor.
From our pharmacist’s overview on the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate page
“If you take a birth control pill that combines ethinyl estradiol, norethindrone, and iron (Loestrin Fe, Estrostep Fe, Microgestin Fe), a few supplements can genuinely undermine it, and I want you to know which ones first. Six of the 240 ingredients on file carry a major rating.”
Reviewed by 2 · Jul 18, 2026
Open the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate interaction page
Taking Sage as Part of a Dietary Supplement Product? Check It for Interactions
We hold 718 real supplement products containing Sage, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Sage. Your product may carry other ingredients that interact with Ethinyl Estradiol, Norethindrone, Ferrous Fumarate too, on top of Sage — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Sage and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate Sit Against Everything Else
Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.
#227 of 1,452 supplements looked up here in the last 7 days
#250 of 2,830 medications looked up here in the last 7 days
Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.
About Sage
What is Sage?
- Sore throat and mouth irritation
- Digestive upset
- Excessive sweating
- Memory and thinking
- Menopause symptoms (hot flashes)
- General antioxidant support
Sage is a common kitchen herb that is generally safe in food amounts and is traditionally used for sore throats, digestion, sweating, and memory. Some early research is encouraging for sore throat and menopausal hot flashes, but most uses are not well proven. Concentrated extracts and the essential oil should be used carefully because high doses contain a compound called thujone, which can be harmful.
Other Drugs & Sage
Browse every other medication we’ve checked against Sage — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,296 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Ranitidine ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Glycopyrrolate ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Triamcinolone ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Ipratropium ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Procainamide ›
- Trimipramine ›
- Acetaminophen ›
Showing 60 of 1,296 moderate interactions — see all 1,296 on the Sage page.
No interaction 1,533 drugs checked — show the list
We also checked Sage against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Rosuvastatin ›
- Aspirin ›
- Isotretinoin ›
- Levothyroxine, Liothyronine ›
- Docusate ›
- Hydroxyurea ›
- Valacyclovir ›
- Sumatriptan ›
- Methotrexate ›
- Amoxicillin ›
- Bupropion ›
- Azithromycin ›
- Bendamustine ›
- Acyclovir ›
- Methylene Blue ›
- Ciprofloxacin ›
- Amoxicillin, Clavulanate Potassium ›
- Acetylsalicylic Acid ›
- Aluminum Hydroxide, Aspirin, Magnesium Hydroxide ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Aspirin, Butalbital ›
- Cephalexin ›
- Ezetimibe ›
- Bismuth Subcarbonate, Calcium Carbonate, Opium ›
- Isoniazid, Pyrazinamide, Rifampin ›
- Levodopa ›
- Cyclopentolate ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Daunorubicin, Cytarabine ›
- Alginic Acid, Aluminum Hydroxide ›
- Sodium Bicarbonate (otc Drug) ›
- Efgartigimod Alfa-fcab ›
- Measles, Mumps, Rubella Virus Live ›
- Carbidopa, Levodopa ›
- Thyroid Hormone ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Peginterferon Alfa-2a, Ribavirin ›
- Cytomegalovirus Immune Globulin ›
- Aminolevulinic Acid Hydrochloride ›
- Sulfadiazine, Trimethoprim ›
- Glycerol Phenylbutyrate ›
- Tubocurarine ›
- Alpha-1 Proteinase Inhibitor ›
- Lonapegsomatropin-tcgd ›
- Articaine, Epinephrine ›
- Daxibotulinumtoxina-lanm ›
- Roxithromycin ›
- Human Papillomavirus Vaccine ›
- Neomycin, Polymyxin B, Gramicidin ›
- Charcoal (otc Drug) ›
- Levothyroxine Sodium ›
- Imipenem, Cilastatin, Relebactam ›
- Cefaclor ›
- Magnesium Hydroxide (otc Drug) ›
- Psyllium , Senna (otc Drug) ›
- Dihydroxyaluminum Sodium Carbonate ›
- Mitomycin ›
- Bismuth Subgallate (otc Drug) ›
Showing the 60 most looked-up of 1,533 medications checked with no known interaction — see the full Sage list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Ethinyl Estradiol, Norethindrone, Ferrous Fumarate Is Linked to Lower Levels of 7 Nutrients
Natural Medicines records Ethinyl Estradiol, Norethindrone, Ferrous Fumarate as a medicine that can lower these. This is not an interaction with Sage — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Ethinyl Estradiol, Norethindrone, Ferrous Fumarate nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Sage and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate Together: Common Questions
Can you take Sage with Ethinyl Estradiol, Norethindrone, Ferrous Fumarate?
Why are there 3 interactions listed for Sage and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate?
How serious is the Sage and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.